Because of its unique history psychoanalysis has, to a large measure, remained under the influence of Freud's theoretical and technical vision of what constituted psychoanalysis. His ideas about the unconscious as the repository of both repressed early life experience, as well as of instinctual drives that continue to influence the individual without his or her awareness, were fundamental to his thinking. In order to access the unconscious, he laid down rules about the analyst's technique that included that he the analyst remain neutral, abstinent, and anonymous. Anonymity was important in order for the patient to project onto him aspects of their unconscious past, its drives in the form of wishes; Oedipal wishes, in particular, being seen and privileged as of central importance to the success of any analysis. Analytic theorists who followed Freud attempted to maintain loyalty to his ideas even when they added concepts to theory that were designed to replace his emphasis on the Oedipal phase. Melanie Klein launched an entire body of theory that broadened what Freud had proposed to include the pre-verbal early years of life, which he had specifically declared outside the scope of psychoanalysis as a therapy. Namely, Klein intended by placing emphasis on the infant's mind during the first year of life to include the major psychosis in her explanatory theoretical position; the paranoid-schizoid and depressive phases allowed Klein and her followers to include major psychotic disorders, what we would now call the Axis I illnesses, in the form of something basic to the human mind as it develops. The appeal of Klein's theories to large parts of the analytic world speaks for itself as to the enduring popularity of Klein's ideas, particularly the existence of a psychotic core in all individuals and the importance of the development from the paranoid position to the depressive position. The triumph of Kleinian theory, in either its original iteration or as modified by her followers such as Bion, is more easy to observe than it is to explain. The
history of psychoanalytic theory and the direction it has moved in has received little in the way of explanation as to why Freud's theory has fared so poorly in much of the world where major modifications of his theory have prevailed. The answer to this question may well have to do with the requirements of the technique which Freud prescribed as necessary to apply his theory with any patient in traditional psychoanalysis.
At the center of Freud's triad of technical suggestions (actually demands) is the analyst's anonymity, his or her neutrality as in the absence of judgmental responses, and abstinence when it comes to transference gratifications. The constrictions imposed by the analyst who adhered to these rules on himself were clearly manifest in the ego psychology version of psychoanalysis that came to dominate North American psychoanalysts, particularly in the hands of psychiatrist-psychoanalysts, who found the more scientific appearing aspect of ego psychology compatible with a doctor patient relationship, one that fit the medical model and, as such, convinced both analyst and patient of a conventionally acceptable form of treatment. The simplicity of the directions, routinely given by the analyst to his or her patient, initiated a process that was designed to have phases, a beginning or initial, middle, and final or termination phase of the analysis. Once instructed to lay on the couch, four or five times a week, the patient was told to say everything that came to mind, omitting nothing, no matter how seemingly aggressive or sexual, and potentially embarrassing to either the patient or the analyst. The importance of free association was enshrined in Kris's book, Free Association: Method and Process, which in itself justified the primacy of free association as giving access to the unconscious mind, where breaks in the associations or connections between a stream of associations was seen as the analyst's tool for uncovering what lay below the surface of rationality that, without the couch and free association, would remain the patient's anchor in unhelpful talk about his or her life based upon his conscious mind. The couch, with the analyst out of the patient's sight, coupled with the demand of saying everything, would undo the dominance of the conscious mind with its ability to filter out the raw instincts of irrationality that were believed to be casual in producing symptoms and affects in the patient's life. Paul Myerson, a traditional ego psychological analyst, wrote Childhood Dialogues and the Lifting of Repression: Character Structure and Psychoanalytic Technique in which he defined
the goal of psychoanalysis as helping the patient make contact with his or her drives in the sphere of aggression and sexuality, something that he believed would be much more difficult or improbable if the patient's parents had failed to be verbally communicative and non-authoritarian when talking to him as a young child.
Some version of ego psychology dominated in the United States for many decades, successfully keeping competing theoretical schools at bay until it no longer was able to keep control over theory. The degree of domination that it managed to maintain was in itself ultimately the reason for its decline. The work of Charles Brenner and Jacob Arlow enshrined the structural hypothesis with its neat division of the mind into three parts, the ego, the id, and the super-ego, all of which were involved in managing the balance between drives and defense. Anna Freud's The Ego and the Mechanisms of Defense served as a manual of defenses which were elaborated and expanded by many ego psychologists. A therapeutic result was attributed to the realization of Freud's dictum that ego now was where the id previously had been; the drives would be mitigated or tamed by insight into their existence which had previously been denied by the individual who was in their grip. In Paul Grey's version of ego psychology, later elaborated by Fred Busch in many articles and books, the analyst was placed in the position, not so much as he or she who knew the answers, but as a careful worker observing the associations moving in front of him, until some aspect of the unconscious could be spotted and called to the patient's attention. Busch added the perspective that the patient's anxiety about deeper material beginning to emerge could only be mined if the analyst tuned in when the patient was in the “neighborhood.” By this he meant that the patient had explored enough to be open to seeing deeper drive based material.
The theory of ego psychology was particularly suited to a continuation of classical technique. It resulted in a very silent psychoanalyst, one who was seldom heard, but when he did speak it was to encourage more free association or to render an interpretation of a long stream of associations in the hour, or a connection between associations from any previous hour and the present one. The analyst was saved from the position of being the all-knowing interpreter of the patient's unconscious, a position that risked the accusation of omnipotence from both the patient and from himself. Instead, he became the purveyor of analytic proof, a
proof that resided in the ability to demonstrate to the patient that what he interpreted could be proven by examining the patient's associations that proved the correctness of the analyst's interpretation. Dale Boesky, among other classical ego psychologists, wrote extensively about what he called “psychoanalytic proof.” The analyst, as a person, was safe from participation in what was assumed to be a particularly intimate dyadic relationship, one in which the transference and counter-transference became increasingly the source of rich material, in dreams and associations, that contained important passions, both sexual and aggressive in nature. This assumption, however, ignored the fact that the intimacy was one sided; the patient revealed everything about himself while the analyst remained anonymous. He participated from behind a professional safe, anonymous self. He did participate by his interpretations but his feelings were to be seen as countertransference and, as such, needed to be contained, split off, for his own consideration, but not to be shared with the patient.
External reality was widely seen as irrelevant or even more likely the enemy of a true analysis. Hence, patients in a crisis, acute or chronic, were seen as not suitable for a continuing analysis of intra-psychic conflict; the very thing, or the only thing, that really allowed a patient to be an analysand in the true sense of the concept. Any analytic treatment where the reality of the patient's life issues didn't fade into the background could be seen as a failure of selection; the analyst had simply taken the wrong type of patient into analysis. If an analysis was working the patient's thoughts, wishes, and drives would be focused on the analyst. Weekends, in particular, were seen as an interruption in the patient's relationship to the analyst with the result that many things that occurred over a weekend were interpreted or brought back to the impact of the interruption. The analyst's vacations or interruptions for illness or family demands became the focus of analytic hours leading up to the break, and then analyzed after the break. The search for the intra-psychic conflicts as the exclusive arena for psychoanalysis was from a very early point in the growth of analysis in the United States opposed by Harry Stack Sullivan and Clara Thompson, who strongly believed that the nature of the environment that a patient developed in greatly influenced the problems in living that each patient experienced in adult life. The child was, in the eyes of the inter-personal school of analysts, programed to react in patterned ways
that had been part of the family culture. The behavior of the parents explained much that one could see in the patients that they analyzed. This assertion of difference cost the interpersonal school analysts a great deal. They were simply exiled from the American Psychoanalytic Association, literally driven out of a national meeting having been stripped of their membership. After being driven out of the APsaA they grouped together to form the William Alanson White Institute, a New York phenomenon, that provided a home for likeminded psychoanalysts, many of whom were psychologists rather than psychiatrists.
The interpersonal perspective morphed into the relational approach and, in doing so, began to create an approach to patients that differed significantly from the ego psychological perspective. However, they did so without specifying any change in technique other than to see their patients at a three-times-per-week frequency and have them sitting up instead of lying on a couch. While their theoretical differences combined with these two technical changes implied a different position for the psychoanalyst, they remained tied to the terms transference and counter-transference, implying the continued acceptance of analysis as not including a real relationship. Even allowing for the influence of a face-to-face position, there is little to indicate where the relational school stands with regard to the important issue of self-disclosure on the analyst's part. For that matter, the relational school left much of the traditional approach apparently in place, instead emphasizing the concept of enactment. By this they are referring to something that happens between analyst and patient that is only observed and analyzed after it has taken place. It has a kind of “eureka” feel to it when the analyst recognizes that he has been participating in enacting a role in the patient's unconscious or patterned behavior that he has been unaware of. The implication of this emphasis on enactments within the relational approach is that the analyst has, in some fashion, been more active, more of a participant and then an observer, rather than a participant-observer as in the interpersonal perspective. The analyst through his activity has failed to remain a detached and neutral participant in the dyadic relationship. However, in relational circles, this is seen not as the result of a failure of technique, but rather an inevitable outcome of the analyst's willingness to participate in some more active a fashion than was traditionally considered permissible.
Self-disclosure has been a touchstone in the rather tortured approach to openness on the analyst's part about who they are and what they feel about life and about their patients. Among traditional analysts in the United States, it has been viewed as a failure on the analyst's part; an indication that his training analysis failed to help him master the capacity for anonymity, abstinence and neutrality, producing an incomplete psychoanalyst still too inclined to be involved with his patient as a real person. If seen from a certain progressive perspective many aspects of classical psychoanalytic technique have been designed to create a functional dyadic relationship that is almost entirely impersonal in nature where the analyst is concerned. If the details of the analyst's background or his political views or religious observation or non-observation have been disclosed, or enter into the analytic dialogue, it has been assumed that this will truncate the development of the supposedly necessary “transference neurosis.” Like many of the received wisdoms of psychoanalysis in the Freudian tradition, little has been subject to questioning, no less revision, or retirement of the concept. The fear of self-disclosure has continued to dominate not just those who are psychoanalytically trained and oriented. Therapists of many different schools continue to accept the technical rule of anonymity despite being CBT or DBT specialists. The power of psychoanalytic rules for technique cannot be overestimated simply because it has only been in psychoanalysis that such rules have been promulgated and maintained as established without any proof, experimentally or clinically, to prove their importance or their effectiveness.
The desire for an impersonal but nevertheless intimate and intense relationship between psychoanalyst and patient has its roots in a number of issues that have occurred during many decades of psychoanalytic practice. The concept of the “erotic transference” as a common and perhaps inevitable outcome of having a female patient on the couch with a male psychoanalyst behind that couch somehow was accepted as an established reality without any consideration of how frequently such a transference did appear and consideration of what the diagnosis of the patients who developed such a sexualized love for her analyst actually was. Once the idea of transference took hold in the psychoanalytic world, the existence of an erotic transference as an inevitability was accepted as bedrock; it was an entity that wasn't to be questioned. As a result, it was
often looked for and found by psychoanalysts of varying perspectives, and even being seen as a hallmark of heterosexuality in a female patient. It's absence needed to be understood as representing something missing in the analysis of a woman patient by a male analyst. Less was said about the situation, transference wise, when the patient was male with a female analyst but basically a similar transference was felt to be inevitable. It is likely that the erotic transference did become a lively and disruptive feature when the patient was a woman with the type of instability that we characterize as typical of borderline personality disordered patients. Such patients, as a result of their loose boundaries, were seen as proof of the existence and importance of the erotic transference. This sometimes did result in actual sexual activity between such a patient and a male analyst who himself had an absence of needed boundaries, with the result of a sexually passionate relationship that somehow always had a bad outcome for both patient and analyst.
However, the majority of sexual romances between analyst and patient tended to be between a male analyst and a female candidate who was in analysis as part of her training. While the profession condemned such relationships and labeled them as acting out between a poorly trained analyst and a seducible female candidate, it is plausible to consider these relationships as rather like the affairs that sometimes occur when a married man meets and falls into a relationship with a desirable woman. The fear of such an occurrence within the psychoanalytic profession has been a major contribution to supporting the need for a distance between patient and analyst. Self-disclosure was viewed as the beginning of what could become a “slippery slope” that would result in a dangerous degree of relatedness between and within the analytic dyad. In order to preserve the analyzing function of the analyst, it was deemed necessary that both participants managed to minimize their actual relationship as two participating adults. The erotic transference, when accepted as a given, has contributed to the demand for adherence to technical practices that keep psychoanalysis distant from the personal with regard to both the patient and analyst. However, it is the analyst who is officially entitled to concealment of most, if not all, details of their personal and emotional life. Added to this is the tendency for the analyst to work from behind a professional self, one that conceals his feelings about himself, his work, life in general, in order to preserve his analyzing function.
The original model of psychoanalysis defined access to the drive-derivatives in the form of wishes as its goal. The lifting of repression that kept the infantile out of consciousness justified a strict adherence to neutrality, anonymity and abstinence on the analyst's part. The person of the analyst, his special proclivities as an individual, his politics, his esthetics were his to show in his personal life but not during his functioning as a psychoanalyst. The journalist Janet Malcolm in her book, The Impossible Profession, created a picture of a typical psychoanalyst that vividly described the analyst of that period with his plain office, the absence of any original art (just reproductions of well-known paintings), as well as any photographs of family members, maybe a portrait of Freud and of course a simple couch, an analytic couch that resembled a day bed. The analyst himself was conservatively dressed with a suit and tie, sometimes a vest, he was permitted to smoke while taking copious, often verbatim notes on the patient's associations and his interpretations, if and when he felt it important to intrude upon the patient's free associations to render an interpretation. It was considered best for interpretations to be spare and concise in order to make an impact upon the patient, certainly nothing like a conversational rhythm or tone was to be present.
For many analysts the requirements of technique were comfortable and for some even exactly matched to their personalities. Seriousness, even carried to a point of dourness, seemed to be the personality style of many who were drawn to psychoanalysis. It was a time of conventionality, where family values and a dignified style in those selected to be candidates in training were searched for by institutes of the American Psychoanalytic Association. If by practice, rather than overt rule, all homosexual psychiatrists were considered unanalyzable and unsuitable for psychoanalytic training. Divorce was an anathema because it revealed that a candidate wasn't capable of object constancy or that he failed to recognize that his anger at his wife actually was a derivative of his unanalyzed relationship to his mother. A tight control of who, after graduation, could be elevated to a training analyst position insured that the elite analysts would constitute the Institute, the important part where decisions about candidates and education were made, while the remaining, less elevated analysts would form the Society of that particular institute. By maintaining such a model, each institute could guarantee the continuity of the culture of that institute. The training analyst committee consisting
of training analysts only would select graduate analysts who they felt were worthy of being considered for elevation to TA. Even then these candidates would be screened, interviewed, and all the TAs questioned about the acceptability of that now invited applicant. If any powerful TA objected to the person being considered it was likely that elevation to TA would be impossible for that individual. The number of TAs was kept small enough for each TA to have a sizable number of candidates on their couch; this made it possible for the TAs to have a secure income as most training analyses lasted well over five years.
The effectiveness of this organizational system was undeniable; most important was the ability of the training analyst group at any local institute to reproduce itself. Since graduates could only apply when “tapped” or selected to be considered by the TAs, other talented individual analysts could be ignored. As a result, the TA establishment essentially reproduced itself with great reliability. This meant that, whether wittingly or not, only those analysts whose personality fit with the established group were asked to join. Of course, mistakes were made, particularly when an analyst had written an impressive paper or more, but once elevated to TA status most of these individuals quickly learned to fall in line and not rock the boat by being outspoken about any controversial issue. The stability of successful institutes like the Boston Psychoanalytic Society and Institute (BPSI) and the New York Psychoanalytic Institute (NYPI) were impressive, although they differed from each other probably on the basis of contrast in Boston types (proper and unassuming) as opposed to New York types (aggressive and outspoken) of personalities.
The harmony among the TA group did begin to break down probably because of a number of factors. First, in Boston, for instance, those analysts who had been considered for elevation to TA but turned down began to protest that the TA selection committee included no non-TA members. This was a period in the United States when the absolute nature of all hierarchies was being questioned. Students at major universities were demanding to be included on committees that concerned their future as well as that of the university. The response at BPSI was dramatic; a group of TAs were so angered by the insistence that there should be non-TAs on the committee they proposed leaving BPSI to form a new psychoanalytic institute in Boston. Despite the fact that Boston was a rather small city the APsaA approved PINE as a new entity in Boston.
In addition, the dwindling number of psychiatric residents applying for training that followed a shift in psychiatric training to a more psycho-biological orientation directed young psychiatrists away from analytic psychotherapy. The compromise settlement of a lawsuit by three psychologists opened psychoanalytic training to psychologists and eventually this was extended to include social workers. The lessening of a medical approach in turn reduced the influence of ego psychology in general as other approaches advocated by Klein, Bion, Kohut and Lacan combined to influence how psychoanalysis was taught in both the institutes affiliated with the APsaA, as well as those independent institutes that were established after the lawsuit was settled.
The growth of psychoanalytic theory has resulted in a more fragmented field not only with regard to competing theories but in terms of a tendency to “pick and choose” from among theories that are, in themselves, incompatible. Furthermore, as psychiatric residents have increasingly avoided training in psychoanalysis the field has been populated by individuals who, although well trained in psychology and social work, are far removed from the practical demands of medicine that require continuing monitoring for effectiveness of any treatment. Psychoanalysis in the hands of those who know only psychoanalytic theory without reference to pragmatic measures of relief and progress in their patients' lives can easily become entrapped in the view that the theory they believe in is correct and effective, no matter what their patients report about how they are doing. This is vividly illustrated by the work of several Italian psychoanalysts who have enveloped their work in the theories of Bion and Winnicott. Antonio Ferro, for instance, insists that anything other than what happens in the analytic hour should be of no importance to the analyst. In his colorful version of psychoanalysis, the only thing that is, in his language of the kitchen, “cooking” is in the relationship between the analyst and his patient. He reduces the patient's life to a kind of irrelevant position, as in, “the patient says she has a dog, but how do I know if she does,” meaning that he doesn't care about the details of the patient's life. Here, in Ferro, is an example of psychoanalytic reductionism taken to a degree where only the transference-countertransference interaction has meaning that is worth the effort of interpretation.
Traditional psychoanalysis flourished in New York City where the New York Psychoanalytic Institute following analysts like Charles Brenner
and Jacob Arlow codified the structural hypothesis as the very center of psychoanalysis. Their efforts were directed at defining psychoanalysis as a scientifically based therapy that aimed at discovering the causal aspects of human development, as well as human emotional conflict and suffering. By elevating the dual drive hypothesis, they defined psychoanalysis as accounting for all aspects of development. The libidinal and aggressive drives on encountering the defenses against allowing direct expression of the drives resulted in what they called compromise formations. All of human development was seen as a compromise formation and the same was said of all interpersonal interactions. Compromise formation was the center of this infantile drive-defense model. Within this perspective every aspect of the developing individual had to be viewed as the result of a compromise formation, with a resultant product that could be deconstructed to its component parts. The interaction of the drives with the relevant defenses, both of which were largely unconscious, resulted in what could be observed about any individual's sexual and aggressive characteristics.
This model placed the psychoanalyst in the position of knowing what was really occurring with a patient no matter how much the patient found an interpretation to be wrong, irrelevant, or harmful. Furthermore, this role, which was at the center of ego psychology, the analytic approach that gained almost complete acceptance and dominance in the U.S. and North America, reinforced the idea of technical excellence built around anonymity, abstinence and neutrality. The character and personality of the analyst, in this vision of psychoanalysis was not only irrelevant but a danger to a therapy remaining in the realm of what could be properly called psychoanalysis. The demands on the analyst to remain a listening and interpreting object were seen as a kind of badge of courage. The enduring analyst was one who could keep themselves and their emotions out of the field even at great sacrifice to themselves of human involvement in the lives of their patients. A true psychoanalyst could, in their personal life, be lively, funny, compassionate, a great colleague, and friend, but all of this was to disappear when in his or her professional role as listener for and interpreter of the unconscious. While it is popular now to deny that this could ever be what we as psychoanalysts believed was at the core of our functioning, it remains true that it did exist as a view and that view has continued to influence analysts to work
from an anonymous position. While this attitude towards revealing one's personal history and life to patients during the course of an analysis is claimed by contemporary conflict theory analysts to not continue to be the case, there is much evidence that it continues to influence many, if not most, psychoanalysts in the United States as well as in the rest of the world. From this perspective no self-disclosure should be part of a routine analysis. If it did unfortunately occur, it was necessary that the analyst be able to justify such an occurrence on the basis of the unconscious relationship within the dyad at the particular moment of self-disclosure.
The anonymous analyst in all of the traditional schools of analysis meant that you, as the analyst, was the serious, functional adult in the consulting room. Analysts were to be seen as serious individuals who remained dedicated to the task of analyzing the intra-psychic conflicts of their patients. The patient on the couch was asked to regress and believed to be like a child in a parent (analyst), child (patient), relationship. The analysts needed to carefully protect themselves in their personal lives or, as depicted in the movie, “What about Bob,” the patient might be expected to invade your life by acting out their fascination with the analyst's life. The desire of a patient to literally become totally focused on the analyst's life, his choices and his preferences was seen as an inevitable problem if the analyst responded to the patient's curiosity by answering questions about his personal life. The infantile unconscious was seen as insatiable once a transference neurosis has taken hold within the analytic dyad.
Because there are some patients with inadequate character structures to maintain a separation between a real therapeutic relationship when it allows the analyst to be known as a person with specific other relationships in his life, it has led to the conclusion that this is a danger with all patients in analysis. Clinicians who have been burnt by patients with borderline personality disorders, patients who respond with intense, erotic and aggressive involvements with the analyst, have contributed to making anonymity, or at least mostly remaining anonymous, seem essential if an analysis isn't to be derailed or “blown up” by the unworkable aspects of analysis with such individuals. When a patient develops affects of erotic love or murderous hate along with the insistence that these feelings are justified by some aspect of the analyst's perceived action, the situation becomes clinically untenable. In addition, it reinforces the received assertion (wisdom) that analysis is a dangerous endeavor
simply because, to be successful it must reach those deeply buried parts of the infantile self that had remained unconscious and bound through repression in all individuals (patients).
If the interdiction against self-disclosure is dropped along with the insistence on neutrality and abstinence, what kind of participation by the analyst should be expected if the therapeutic goals of an analysis are to be enhanced? The traditional austere analyst who was motivated by the desire to undo repression, and in doing so help the patient gain access to their infantile core self, could feel secure in their task because it was so clearly defined and delimited. By maintaining technical requirements, the theory upon which traditional psychoanalysis was based could remain unquestioned. The effort for all theoretical schools to maintain the basic rules of technique has resulted in an absence of models for the analyst's activity, other than interpretation, during the course of an analysis. While much has been made of changes in psychoanalysis in the direction of changing it into a two-person relationship, such claims seem to exist more in their assertion than in the reality of actual practice.
The position of many if not most analysts continues to regard a “real” relationship between analyst and patient in terms of transference and countertransference. These terms are more than mere words when it comes to the encounter between an adult patient who is seeking help for problems and or symptoms of anxiety and depression and an adult psychoanalyst or analytic psychotherapist. Are these two strangers, connected as they are by a professional relationship, not really encountering each other and reacting in accordance to what is real between them? Merton Gill alerted us to the idea that, while everything was transference, nevertheless the perception of the patient regarding the analyst might well be grounded in something real about the analyst. Joseph Lichtenberg suggested that the analyst wear the attributions made about him as if they were real. But, the desire to place the source of an affective response to the analyst on past figures in the patient's life persists. Jane Hall in a recent email exchange attempted to convince me that if a male patient in his twenties felt that I was judging him for his sexual hyperactivity it was probable that the disapproval belonged with his puritanical father. She put this forward as proof that it is always transference, to which, I would say, no, in fact I did disapprove of his indifference to the feelings of the other in a sexual encounter.
Analysts are creatures of habit and often prisoners of theory and basic assumptions. If a new relationship between patient and therapist is supposed to have no basis for emotional reaction because the analyst remains anonymous and therefore cannot have elicited an angry or sexual response when one does occur, habit makes the therapist look to a past figure rather than to themselves. To think outside the habitual framework of feelings in the patient or in the analyst that requires it be seen as a transference or a counter-transference depends upon a certain braveness of spirit in the analyst. If we consider and acknowledge that most training in psychoanalysis doesn't encourage thinking that is critical of received wisdom about either the theory of that institute and certainly not the importance of technical rules, then it becomes clear that a two-person psychoanalysis and adherence to categorizing feelings in the patient or analyst as transference and countertransference is an impossibility. The patient is asked to be completely open, to say everything that comes to mind, to conceal nothing from the analyst, who, on the other hand, is given the privilege and responsibility of remaining anonymous. The power of the anonymous analyst cannot be overestimated. He or she by remaining anonymous gains from a mysteriousness that implies an all knowing or magical persona. This power has proven difficult to give up; to be known in one's actual personality and life is to risk being judged as anything, ranging from nothing special to something that is disapproved of by the patient.
Are you observant of a religion, particularly if the analyst has a Jewish background and the patient is an observant Jew or a Christian, who believes that Jews should be observant? Are you married or divorced? Are you straight or gay? Do you back the democratically-elected President? All of these knotty issues that we all, as therapists, have as positions in our personal life can be hidden from our patients with the rationalization that it is a necessity if a transference neurosis is going to emerge. The price of protecting the transference from being invaded by the reality of the psychoanalyst's personal life and character is to keep the analysis a one-person endeavor. The apparent two-person nature achieved by allowing the analyst to utilize his countertransference responses represents a pseudo two-person entity; it looks like two persons but it is, in actuality, two unconscious entities interacting, with the analyst claiming to himself and to the patient, the accuracy of his interpretation of the
patient's transference, as well as his correct reading of his own counter-transference. To say that there is no real give-and-take or conversation between two adults in an analysis conducted on this basis is an understatement. It perhaps helps us understand the frequent observation, when talking to individuals who have had a traditional psychoanalysis, that what they recall about what was important to them in their experience of their analyst lies in how they recall and describe some small moment of unexpected human exchange with the analyst.
What guidelines are there for any analyst who decides that his role shouldn't be restricted to that of a receptive listener who interprets his patient's associations but remains outside of a personal relationship between himself and his patient? Gabbard, quoting Bion says: “The analyst you become is you and you alone, you have to respect the uniqueness of your own personality—that is what you use, not all these interpretations (these theories that you use to combat the feeling that you are not really an analyst and do not know how to become one).”
However, there is little evidence that in his clinical work Bion actually revealed much if anything about his personal life or his non-professional personality. Gabbard goes further towards defining a more liberated psychoanalyst when he states the following: In 2009 Gabbard and Ogden (On becoming a psychoanalyst, Int J Psa 90:311–327) wrote that “Each time we start an analysis, we have an obligation and responsibility to become an analyst whom we have never been before. This requires that we drop the script and enter into a conversation of a type we have never before experienced.”
But, a great deal is left unsaid as to what dropping the script and entering into a conversation that is unique to each patient will involve or look like. On the surface, Gabbard and Ogden are saying something profound that expresses exactly what I am aiming at in this paper but without spelling out how difficult it is for most analysts to overcome the rules that they were taught as essential to being a psychoanalyst. The past, to paraphrase Faulkner, isn't actually dead, it isn't even past. While it would be appealing to accept the ubiquitous insistence that “we are no longer like that” in regard to our silence and absence of open participation of our actual life and inner state in the analytic dyad, the truth is that this seems more a wished for state of our field than an actual reflection of
how much the past still dominates even from the undercover and disguise that denial provides.
Once an analyst concludes that the basis for all our theories are indeed theoretical and unable to be either disproven or proven, it is possible to face the need to be real with his patients. Without active input and participation from the analyst, it is unlikely that many crucial subjects will be introduced into the dialogue by the patient. In a recent paper, Dorothy Holmes introduced the idea that all analysts should introduce the subject of the patient's probable, or as she sees it, inevitable, racism to the analysis. She is aware of race because as a black woman psychoanalyst she is keenly aware that race can never be a subject that fails to enter the analyses that she conducts. The same can be said for all of us who accept the basic two-person nature of the relationship; contrary to the old rules of anonymity it is crucial to a relation-based analysis that the analyst include and introduce much material that comes from his own life experience and subjective emotional response to events that surround us regardless of the degree to which we involve ourselves in current events, political crises, and mortality. The gradient of the traditional psychoanalytic relationship in which the analyst alone has knowledge of the unconscious aspects of the patient's mind, while keeping track of his own unconscious fantasies and responses, leaves the patient with a residue of an empowered and omnipotent analyst who is to remain unknown as a real person. The changes in the analytic relationship that occur when the analyst allows himself the freedom to participate in an active role serve as a corrective to many of the deficits that are readily apparent in traditional psychoanalytic treatments. In terms of therapeutic action, the presence of the analyst as a real and continuing influence on the patient's capacity to maintain the growth that has occurred during the analysis far exceeds what has been the case after the termination with a traditionally anonymous analyst.